All things must change

Months since the lost post here, much has changed.

Firstly, the job has changed. Where I used to wake terrified and excited each morning, wondering what jobs would come down and if I would be able to handle them, I now wake tired, never feeling like I get enough rest and looking forward to the next set of days off, which seem few and far between.

Not to say I don't still love the job - the excitement still gets me and the adrenaline can still get pumped through my system several times a day on the good days, but the bad days are now more monotonous and 'auto-piloted', as if my body and mind lie in wait of 'the next big job'.

Where once I would have a slight tremble in these 'big jobs', despite knowing exactly what to do and be doing it, my hands are now calm, still - my mind sure and planning at least two steps in advance. I've approached major overdoses, CVA's, respiratory distress and cardiac arrests all with the same confident, calm approach that once seemed so comical about the profession but has now become a stable flow of my life.

The wife is frantic, her husband having overdosed on many tablets of tricyclic antidepressants, his ECG shows things are not looking good and his level of consciousness is dropping with each passing second. She runs at him, grabbing him and trying to 'help' move him to our stretcher. I calmly pull her off her husband, force her to face me and not him, tell her how she can help by finding the empty medication wrappers, let us look after him. My partner and I position him laterally, maintain his airway, oxygenate and load him into the Ambulance. The wife has left us, running from room to room as if she can hear the packets calling her, but she cannot quite work out where they are.

Secondly, I have changed. I still make the bad (good) jokes, smile frequently and small talk, but the naievity of my youth is now long gone and I can't help but feel somewhat colder inside. I realise how little of my youth I took advantage of, partying little and studying perhaps too much, and while I know technically I'll still be a youth for several more years I feel older - aged beyond my time. But I am still happy, loved and in love, if anything now appreciating more the sheer preciousness of life, so easily lost, so easily wasted and so easily enjoyed and cherished - made more than just time on this planet, an experience to hold dear and utilise to it's most full. 'On job' I comfort and counsel those who have lost, those who are losing and those who fear for their loved, I show sincerity and understanding and have been told I'm good at it - but it feels as if it comes from someone else, some other source, because in reality I am cold inside to steel myself from the emotional aspect of the daily onslaught of misery we face, and must face.

The wife is crying, sobbing into her hands. We are prepared to leave the scene and she steps up into the Ambulance passenger seat. She was unable to find the medication packets and again feels a failure and powerlessness that only someone watching a loved one dying can ever understand. I tell her that her husband is in a serious condition, but that we are monitoring him closely and will have him at the hospital shortly for definitive care. I comfort her best I can, talk with her to find out more of the details of what had happened, the little facts that at first don't come out but can drastically assist treatment. I weigh our options; try to look myself for the packets, further delaying transport but perhaps having a better idea of what we are up against, or transporting knowing some of the story but getting us to hospital quicker, where many hands make stabilising this patient much easier. On arrival the patient was talking, albeit nonsensically, but now he is only responding to painful stimuli - even then only with much effort. I decide to go with the latter, and we pull out of the driveway.

There is a dangerous balance in this job. Care too much and you can't seperate yourself from your jobs - the misery consumes you and the sheer weight of suffering crushes you. Care too little and you seperate yourself from your jobs completely - you become too cold, burnt out and resenting the patients more and more each day. The balance varies from day to day - sometimes you need to care too much, remind yourself that you are human and the importance of the decisions we make between seconds that can save or damn a human life. Sometimes you need to be cold and untouchable, shield yourself from the onslaught. As long as you can find that middle ground again, survive and endure.

We arrive at hospital and rush him into a Resuscitation suite. A frenzy of bodies, hands, minds and tools check vital signs, draw bloods for analysis and ensure the body stays ventilated,the heart beating sufficiently. The wife is moved to the waiting room for what will be the longest few hours of her life.

The world has changed. Or at least, my understanding of it has. This 'first world' country is far from it. The addage that a person is smart, but people are stupid takes on a greater understanding and the acceptance that people do very strange, often stupid things in 'emergencies' is made. People live in squallor. People live in filth. People live in luxurious mansions with bedcovers that cost more than I make in a month. People have children, children have children. People make mistakes. People get hurt, get sick, get old.

People die.

I always knew about and understood death, but there is a familiarity you make with it after many encounters. There is an essence to it, a feel that cannot be described or conveyed. Sometimes even an anticipation en route to the scene, somehow we know what we will find.

The wife has gone home, although I doubt sleep will find her tonight. Her husbands blood still moves around the body, oxygenated and delivering nutrience to the organs. He is to be transferred to another hospital for acute high dependancy care, although his outcome remains unknown.

We have finished our paperwork, submitted the report to the hospital and move back to the car. We push the little button to make us 'Available' again, and we await the next job. As always we don't have to wait long, and a siren wails off into the night, the previous job cleared from the mind as routines, protocols and plans are laid for the next patient.

All things change, but for now I know where I am in life, where I am going and what roads lie ahead. 

And I am happy.

Morning Mist Part 2

The mist is back this morning... Calm, beautiful, like the last breath of air the earth ever takes.

He lies in the grass, motionless. He's been still for quite some time, and the mist has claimed him as her own. Two dogs - his dogs - bark at the gate a meter away, one excited by this strange new game his master has come up with, the other angry that these two men were probing their master, connecting strange things to him and shaking their heads slowly.

They were young dogs, with many years left in them. Their master, also young, unfortunately did not.

The two men walk back to their van, nodding to the other men, police, that the job was done. Their breath mists in the cool morning, tiny clouds fall and vanish almost before you could acknowledge them...

Two dogs bark, the men drive away, leaving the master in the care of the mist.

Cool little things...

One of the cool things about my course right now is that I'm backwards diagnosing some of my old patients...

Boy with big floppy ankle? Oh - he had a Potts fracture! Lovely old lady with Angina? Unresponsive to her sublingual spray and duration of pain makes that a possible AMI (and makes me very happy I called the ambulance!). Carpal spasm? Hypoventilation due to drug use!

You get the point...

Looking back on most of the patients I don't think I'd have done anything differently back then... which is a good thing I think... Doing it now, I'd do a lot more - but only because now I have that extra training, knowledge and resources I'd be more confident in my treatments. There were times when I wished I could administer advanced pain relief, confidently read an ECG or even just move the patient in some circumstances - none of which I was legally allowed to do with St John.

I guess my point today is this; from here on in I'll get to do all of the cool little things that make big differences in patient comfort and outcome...


Until of course I go up the next training scale and look back again!

What you won't find in a book

As a friend of mine pointed out in a comment to a recent post, there are a lot of things that don't get taught in any book. The feeling of looking at someone and knowing how little chance they have. The desperation in your heart and hands as family members look on to you pumping oxygen into their loved ones lungs because they stopped breathing on their own. The look of children on their grandmothers face as her 'chest pain' gets worse, isn't responding to the 'nice mans' medication and the ambulance is yet to arrive.

There are a lot of things that can't be taught through any book, partly because they're experiences you simply wouldn't want to share with others, partly because they can't be described in words. These are the quiet moments where you look into your soul and see yourself as a mortal being, rife with fissures and cracks - ready to break at any moment.

These are the moments when people look at you - the medical professional - and expect you to have some miraculous therapy or treatment to help the person they love keep living, and as much as I would love it we usually don't have the answer they would like.

As my friend rightly puts it, "this is definitely going to be one of the hardest things to do..."

Unfortunately it's something we'll have to get used to doing, after all, we all have to die of something - and with modern medicine people are living longer but dying in hospitals as we try to squeeze every last drop of life from their body.

The hospital giveth, the hospital taketh away.

Thoughts so far

Well, almost at the end of another week of training and I have a few thoughts about it so far...

It's intense - the sheer volume of information, whilst not overly complicated material, is overwhelming. Despite this - I love it. Even though I'm yet to go on road, the nature of the training we are receiving and the skills we're expanding on every day makes me wake up each morning (still sleepy and irritable, but also) excited and ready for another day.

But it isn't all perks. When we first got here we started a line of questioning for some of the senior paramedics, a way of getting to know the things about the job that the public don't hear. Best job, worst job, goriest job and saddest job - the story that's stayed with me the longest comes from one mans saddest story...

He was called to a possibly deceased and when he arrived, sure enough there was a deceased man laying there. He had been dead for possibly several hours, and no attempt at bringing him back was going to be necessary. He was an elderly man, the person who made the call was his wife who had found him 'sleeping' in their bed. After telling her the bad news, she sat there silent for a moment.
"But... what do I do now?" was all she asked. They had been married for over 60 years - every day together, every moment shared. She had spent vastly more of her life with this man than without, and just like that - he was gone.

These are the situations we don't have protocols for, that we can't train for no matter how hard we try. These are the hardest parts of the job and the real test of strength.

I like to think that one day I can stand in front of a class of new recruits and tell them my stories - the best, the worst, the goriest and the saddest. I just hope mine isn't so sad - but I know it will be, and that it's a part of what the role entails. I want to be good at this, and then I want to be better - I'm not doubting myself, but I hope I have the strength.

That's something you won't know until you're standing in front of that frail old lady, alone for the first time in decades and scared, tears welling in her eyes as you desperately try to stop the ones welling in yours.

We have liftoff

Well, here I am. It's now the second day of commencing my new role as a Trainee Paramedic and I'm loving it so far. The people are fantastic - the training staff are friendly and eager to teach you (although frequently reminding you that there is a LOT of content to cover in very little time), the higher level trainees and other staff keep reminding you to hold on while sharing their stories and the people in my class are awesome. They come from all walks of life, from a gym trainer to a carpenter to a physiotherapist - even a fellow biochemist!

I have to admit, so far I am thanking my lucky stars for my medical background, which has made the content so far fairly simple to learn. A lot of others without the background are starting to worry, but we're going to run some study groups lead by those who have the background (I'll be helping with chemistry, metabolism, anatomy and physiology) so that we'll all feed off each others strengths.

This class comradery was fairly apparent from word go (although most of us are still trying to figure out who everyone is!), and I'm truly inspired by the general atmosphere of the 'family' of the ambulance service.

I'm getting my uniform fitted tomorrow which should be fun - but till then back to study!

Of Mice and Men

I decided to get into healthcare because I felt like I wanted to make a difference. I wanted to reach out to those in need and make them better, happier or just plain alive.

It was a very short time in my life where I held those convictions, because very quickly I realised how little difference you can make, how a lot of the time reaching out to those in need can earn you a punch, that gentle words and proper treatment doesn't always help the pain, and some people you just can't keep alive, no matter how hard you try.

Despite this, I still found the work rewarding - the small victories keep you going. I loved the hands on nature of the work, chatting with different people and hearing their stories. I loved the random 'How the hell did you manage that?' casualties and the ones that make you think on your feet - sometimes literally, as you wheel a patient across to the acute casualty post.

Some patients stay with you long after you've handed them over, be it by their past, their present and why you're seeing them now or because you know what the future holds for them. A while ago I had a patient that stayed with me for all three reasons.

He was in his early thirties and had been walking home from a night out with friends. He had severe skeletal deformities of congenital origins, the details of which I'll go into in another post. I only mention this here so you'll appreciate further the next sentence. He was beaten - bloodied and bruised - by a mob of bypassers for no reason other than he looked different and was unable to defend himself. They had thrown him down and kicked him repeatedly until he had stopped crying - his arms, legs, chest and even his head.

A civilian happened to drive by approximately ten minutes after the attack and noticed him lying in the bushes, almost invisible in the night and had pulled over to see if he was ok, had noticed me driving by in a marked vehicle and flagged me down.

He was taken to the ED, examined and was found to have 'minor injuries', but was in quite a deal of pain. Combined with his history was going to spend a night or two in ward for observation.

This job stayed with me for quite some time after the attack, the sheer stupidity of it and the damage ignorance had caused. I have no doubts that alcohol was a contributing factor in this attack, and that this is becoming a larger problem each week. Still, this wasn't the first beating I'd had to treat and I wish (oh how I wish) it would be the last - but I know the world doesn't work like that. People are always going to do stupid things for no reason, sometimes damaging the life of another. 'Tough' guys with something to prove beating up an innocent, crippled man.

Despite helping clean him up, treat his injuries, I felt powerless to do anything significant at all. But he thanked me for my help, and despite my feelings of ineffectiveness I felt maybe I had achieved something - even if it was just to reassure him that he was still alive.

Some patients stay with you longer than others, but in some way every patient's story changes you forever. You're never quite the same person after a big job, be it for good or ill, but I like to think of it as I'm always growing. Each day, each job makes me a better person, maybe not from gaining hands on experience but by hearing someone's stories, watching their plight and coming through it. Through their strength I gain my own strength, through their struggles I can overcome my own.

For that I am always thankful, and ever wanting to be better at what I do.

Working with Patients: Common sense, a bit of medical knowledge and a dash of art

Most of what I’ve come to find when working with a patient is that there are three factors that need to be taken into account to ensure the process goes well for everyone; common sense, medical knowledge and a certain finesse that you have a little of at first and develop with practice.

I’ve heard of a few Paramedics becoming qualified through a three year university degree, started working on the job and realized they either hated it or were no good at it. This is incredibly sad – imagine spending three years of your life, as well as accumulating a massive financial debt to find it isn’t for you. While of course you have the option of translating that knowledge to another field (as I have done with a medical research background) to ‘save’ some of the effort – I’m fortunate enough to still intend on returning to research (long) down the track when the situation improves.

The trick lies in balancing those three factors of sense, knowledge and art to the benefit of the patient and enjoying it. Bowel pain could be cancer. But it also could be related to the aspirin and beer they took earlier. Common sense differentiates the two. But combined with other symptoms, your medical knowledge may flip that back to the cancer scenario, and you recommend further checks. The art is knowing when to use what – as well as how to relate all this back to the patient.

It’s this constant juggling that appeals to me – I like to think I’m a creative person (I play two instruments, design websites and am about to dabble in photography), I like to think I’ve got medical knowledge (BBMedSc(Hons), SFA w.AdvResus inc. SAED, HAZMAT and BIOHAZ trained) but know I still have a lot to learn (especially regarding emergency medicine) and in the common sense department I feel confident – but I can always do with a little bit more! A couple of times I’ve come up with a plausible diagnosis that was previously missed or hypothesized a scenario which has later been revealed as correct – but all of this means nothing if you don’t know how to work with patients.

A patient (usually) doesn’t have your medical knowledge, and so for them this triangle is incomplete, they’re often in pain and in whole the experience is unpleasant. Working with patients is in its own right an art form, a delicate dance of trust, respect, care and assurance. To be able to assess, if possible reassure and always relate the situation back to the patient is an integral part of the work, and something I have thoroughly enjoyed so far.

As always, I want to be better at what I do, and perfecting this balance is something I see myself being devoted to for some time.

A growing burden on us all

As mentioned last post, the growing rate of binge drinkers is, in my opinion, becoming an epidemic in Australia. Worse still is the younger age of onset, with 14 year olds being given addiction counseling for drinking habits. Despite previous posts implying that the vomiting, wasting our time and resources as well as the physical discomfort associated with working with the soberly challenged being the bad parts of heavy drinking – the really bad parts are things I’ve never really mentioned.

I’ve seen families being torn apart following a member binge drinking, with often fights spilling out into the street as they leave whatever venue they’re in. I can only imagine what this must be like at home. I’ve seen ‘normally quiet, fun-loving and calm’ (friends testimonies) people swear, spit and bite and those trying to help them – including their friends. The toll taken on the private lives of binge drinkers, their families and friends is phenomenal.

Add to that any medical costs for ambulances and hospital care, police fines for drunk and disorderly, public nuisance and the financial toll becomes enormous, on top of the funds required to actually purchase the alcohol. To make this final step easier, liquor suppliers are more than happy to provide you with cask or clearskin wine at a fraction of normal costs and budget spirits and beers to keep you happy. Thanks.

Add to that the cost of a liver failing on you. Kidneys can no longer keep up with the demands being placed on them. Eyesight can fail as the small vessels that supply blood slowly waste away. Internal organs die as they’re literally preserved (and not in the good way) inside the living body. If you try and stop you might go into alcoholic seizures, your body going through withdrawal of its vicious routine. This doesn’t just happen to every-day-and-night drinkers, this can happen to those who binge drink only one or two nights a week. The physiological cost is your life – in every sense of the word.

When I recently got called to a young woman who felt the need to drink an entire bottle of spirits I wasn’t laughing about it like her friends. It’s almost a given that at parties like the one I was at there’s at least one person in this state – it’s a joke that they’ll be teased for over the next few weeks, but nothing more. I usually treat in a ‘kids… *sigh*’ attitude in these situations, which truth be told I did in this case. And, as usual, I gave a brief spiel about the dangers of drinking in excess, both the kids and myself knowing full well that it fell on deaf ears but that it had to be done – as if this too was part of the ritual. I’ve done it enough times now to know it isn’t going to change anything.

I wanted to grab the girl and scream at her – she was a university student, bright and with a good future ahead – was this how she wanted to live her life? It only takes one mistake to ruin an entire life. What if her friends hadn’t been there when she fell? What if she was alone, and started choking on her vomit? What if a sexual predator had found her instead?
A parent came later and took her home, a look of mild amusement on their face behind their outside ‘anger and disappointment’ as if they were internally reminiscing on when they were that age and got drunk. The cycle continues.

God I wish it would stop.

Vomit transfer protocols

I’ve mentioned quite a few cases of dealing with drunks in my short time blogging, but I’m always amazed at the people who feel it’s perfectly normal to put themselves into a state of severe inebriation. Now I’m no saint – I’ve sported more than a few hangovers in my time and, on occasion, put myself into a state of severe inebriation – once following what I’m sure was a reaction to the high preservative levels in extremely cheap wine (I’m allergic to sulphur, of all things…). Thanks go out to Clare for looking after me! (Still sorry…)

I can say however that those events were fairly few and I know for a fact that my days of drinking more than a glass or two are well and truly over. But I’ve noticed some of my friends show a little disappointment in this decision – it’s very Australian to go out to the pub and crawl home.

Working with St John (and also a few bursts of looking after friends at parties) I’ve been abused verbally, had punches thrown at me, had a bag of vomit thrown at me, pulled people out of gardens, been vomited on directly and passively (explanation to follow!). You reach a point where looking after the drunkards makes you realize just how unappealing drinking is – and not just for yourself.

The times I was vomited on directly usually run something like this; security bring someone over who is obviously drunk. They deny being drunk, despite their breath smelling like the bathrooms of Young and Jackson’s Pub following St Patrick’s day and a stupor that would impress a Zen master. After taking their obs they suddenly announce they don’t feel so good, you turn to get an em-bag only to find they project over the bag and onto your uniform. I’m proud to say I have since become the ninja of vomit dodging. Unfortunately, practice made perfect.

The passive vomit stories are the worst though. We get called to a drunk who is passed out in a pool of their own vomit. They are covered in it. A sterna rub or shoulder pinch brings them to (usually angry) but we convince them to sit up. Now we have to walk them over to a post, and the fun begins. We can clean up the vomit off their face and hair, but clothes soak in the stuff – and as we’re sometimes forced to do the old ‘throw your arm around my shoulder’, we get to join in the soaking. Occasionally we’re lucky enough to have waterproof (and hose-clean-capable!) jackets or a scoop and stretcher – but often resources are spread just thin enough to make the shoulder the only quick method of transport. That is passive vomit transfer, and the stink stays for the rest of the duty.

Getting sick and vomiting is only a small part of the problem however – but I’ll save that for next post.

Stay safe.

When vehicles attack!

It's common knowledge that some Paramedics attract certain kinds of jobs - even before I've become a fully qualified Paramedic I know my niche.

I attract car accidents.

Since joining St John Ambulance, I have had at least 8 car accidents happen right in front of me. Normally I'm in civilian clothes, but have my trusty kit in the back of the car (something I highly recommend people get!) and have been able to help out where possible.

Usually they've been low speed collisions, for a long time the most major injury I had to treat was a bleeding scalp following a minor spidering of the windshield. Of course, I made a point of saying 'until recently' because this leads into todays story...

A car was t-boned (one car ramming head first into the side of another) in front of me, the scene instantly turning to chaos. I pulled my car onto the grass and jumped out, kit following me. Fortunately I was in my StJ overalls, so people actually listened when I yelled for an ambulance. The driver who hit head on was fine, walking from the wreckage left behind him with only a look of disbelief and slight tremble of the hands. The driver who was hit side-on was a different story, having not had the luxury of a full crumple zone to lessen the impact.

He said he had lower back pain and pins and needles down his legs, so I told him to stay sitting and try not to move while I did a quick primary survey to check for bleeding. Luckily I didn't find any (although this does not rule out internal bleeds), and quickly jumped into the passenger seat behind him to immobilise the c-spine (his neck) with my hands. Unfortunately I had switched from a marked St John vehicle only a few hours prior, and would have had the luxury of proper fitted collars - but I knew this would do until the ambulance arrived.

To everyone's luck the ambulance arrived in short time and we got a collar on and we got the driver onto a spine board to be loaded. The crew thanked me for my help and everyone went on their way.

This job left a firm thought in my mind that I was doing the right thing by applying for the ambulance service - and also gave me the confidence to believe that I could actually do this. I hated the feeling of not having the equipment I knew I needed, but at the same time enjoyed (not the right word, but you get the idea) the fact I had to think on my feet.

I also learned a quick lesson in patient management, having my friend in the front shifting from time to time (with me grumbling at him to stop each time) until eventually I just warned him he could move one more time, shift something and never be able to move his legs again. It's strange how these words can make a grown man sit as still as a well trained schoolboy.

I wander how he ended up - it's hard not knowing. Hopefully it was nothing but a bit of pressure from a swollen disk, or a pinched nerve that healed itself. There's always the chance that was the last day he ever walked, and I have to be open to that possibility no matter how much I dislike it - being honest with yourself is the only way to survive the job for a long period of time. I doubt I'll ever find out, but I like to hope maybe I made a difference by being there.

Not there yet...

I've mentioned it in a previous post, but it feels time to go through it again due to the simple fact that I've re-read some of these posts and have realised how caught up in it all I've been.

Despite my hopes and ambitions - I'm not a Paramedic (yet).

A friend pointed out that a lot of my posts seem to be narrated as if I had reached that goal already, as if - when talking about Paramedics - I'm relating more as a peer than a student (who hasn't even started at that). To me, this is dangerous territory and something I think I should address sooner rather than later - for my own sake if nothing else. I know I'm nowhere near the level of Paramedic, and the things I've seen and done as a First Aider/First Responder are probably trivial events to the average 'ambo'.

My true challenges lie ahead of me, and I cannot afford to let myself think I am prepared for them yet, because it's the Paramedic (or Doctor, Nurse or even Barista for that matter) who is over-confident that makes mistakes, misses details and generally gives the rest of their profession a bad image. I don't want to fall into that category. Ever.

But to address the issue of relating on a personal level as a peer - in a sense this is something I probably won't stop, not due to the fact I feel as qualified as them (which, believe me, I don't) but for the fact that they are just normal every day humans. Yes - even just like you. They're just trying to do what they can - and to that I relate. I (think I) know how it feels to be doing something that is important to someone's life and health, I know how it feels when it's working, when it's not. When it fails. When it doesn't, and the clouds open up, the sun shines through - and I like the sun, it makes me hopeful. Most of all I know how it feels to want to be better, for their sake - then for yours.

I know I'm not there yet... But I will be.

The problem with makeup...

Some of the concerts I go to with St John provide enough amusement just from the audience - the show itself is just an added bonus. One such night stands out in my mind, however as I'm sure you'll come to understand it was only a while after that I was able to appreciate the situation as humorous.

Without mentioning names, a shock rocker was in town and performing - surely enough St John Ambulance was there to keep an eye on things should said things turn nasty. The crowds were massive, especially for such a fairly small venue, and we were expecting to have a busy night ahead. As usual, we had an 18-30 year old crowd but given the nature of this event most of them were goth - which we all had a giggle at as we walked in.

Oh, how the tables turned on us.

The night quickly became one of the busiest I'd worked for some time and we were frequently swarmed with more patients than Johnno's. Luckily the injuries were usually very minor and more often than not a sit down and a quick drink of water was all they needed, but the time it took to properly triage was extensive.

Why? Well, there was of course the difficulty in assessing their complaints given we were located next to the speakers. Next comes the fact that most of them didn't really want to talk to us. But finally, and most infuriatingly of all, it was impossible to tell at a glance who was genuinely sick or having trouble breathing because everyone was wearing white make up. Everyone came in looking like that were about to 'cease to be'.

It was a good if not frustrating night after all, the crowds almost rioted and we were contemplating a tactical retreat when the main act failed to appear 45 minutes after his set was supposed to start. This created just the right mix of tension and hostility in an already angst filled crowd to keep a steady stream of injured out way...

And here I always thought they 'didn't feel anything...' ;)

Attitude

Sometimes the work I do with St John makes me wonder what I'm getting myself into. Don't get me wrong, when I'm on duty with St John and treating people I feel like I'm doing what I'm supposed to be doing with my life - it's just there are downsides as well as those upsides.

Take this article for example, coming from a very well respected Paramedic from the same city in which I live. I've had the privilege of working with Mr. Eade during my time with St John and have found him a knowledgeable, kind and hard working man - the story does not give him enough praise for his work, but nor would he want it to. But the content of the article raises many issues with the way Paramedicine works in the field - often Paramedics are forced to work in dangerous situations and in increasingly violent environments.

It's not surprising that many Paramedics worldwide want to wear stab vests to protect themselves when on call. Of course a few years back there was the story about an EMS worker wounded by a sniper ambush. There have also been random stabbings, beatings and then there was this story which I don't know where to begin trying to talk about...

I've talked about this with my girlfriend and family and they know some of the risks that are involved in working as a Paramedic - I'm grateful that they all still support my choice. Some might say they are trying to get rid of me, but I like to think they just want me to be happy ;)

Working with St John I've noticed a lot of small things already that make me wonder about some people, I'll run through a few examples so you know what I'm talking about. All the time we get people throwing up behind our vehicles when working at Festival Hall. At the Myer Music Bowl we get people urinating behind (and on) our vehicles. We also get abused when pushing through crowds to get to patients, we get abused by 'friends' of the patient who insist that despite their friends unconscious state 'they don't need [our] help'. Some patients swing at us when we're trying to treat/help them. A while back we were abused for knocking a guys sunglasses off when trying to get to an OD patient, he followed us for a while shouting abuse.

And I couldn't think of any other job I'd rather be in right now.

Now I know (especially when compared to the earlier examples) that what I've experienced so far are only minor irritations compared to what Paramedics encounter every day, but it's the bits that surround those brief moments that make them bearable. It's about getting a non breathing OD patient breathing again that makes a guy following you talking about sunglasses laughable. It's knowing that I enjoy what I do, and that I'm doing something valuable for the community that makes cleaning [censored] covered vehicles easy.

I know I won't always be working in the safest environments (although I will do whatever I can to make them safer for me, and if they're too bad then I won't endanger myself needlessly) and nor will I always receive the respect that I think a Paramedic deserves. In fact, rarely do I think will I receive the respect a health care professional deserves, but at the end of the day I sleep feeling I've done something right - even if things didn't go the way I'd like them to - that makes me love first aid, and wish to continue that into Paramedicine.

And that's the attitude I hope to keep.



Side note; Thursday the 10th of January is my Paramedics Interview and Driving Test (I'm doing two rounds in one day to 'speed up' the enrollment process - their words, not mine *grin*). I'll be sure to let everyone know how it goes!

That's not where I left it...

So today's post will be themed around things not being where they're supposed to be. Namely, body parts.

Recently I came across such a case and it occurred to me that I was not the person I once was. I discovered this when two people walking past the scene stopped and stared at disbelief before swearing with such voracity that even truckers would blush. It hit me then that witnessing dislocations, breaks and bleeding had no effect on me anymore - they were now clinical problems that had to be treated and solved.

The first such incident was a lateral dislocation of the patella (or knee cap to us) - luckily for the patient it had clicked back into place on its own, unfortunately it looked like he had a bit of damage to the tendons. That'll be a fair bit of physiotherapy.

Next came a double break - that's right, the radius and ulna bones of the left upper limb had been snapped clean in two leaving the arm to fling around like a rat on a stick. Manipulation, perhaps surgery and of course physiotherapy.

A dislocated and fractured ankle from a happy fence jumper comes next, the bones pulling on the skin until it was white... Luckily the foot still had blood supply, so just manipulation, surgery and physiotherapy.

Another ?fractured ankle, but a bit of an odd one. There was no swelling, but there was also no sensation at all. Couldn't bear weight or push/pull against my hand. I'm guessing x-rays, maybe ct scans, a few scratches on the head and something from there. And physiotherapy.

A MVC leaves a woman with a whopping bump on the noggin (and a pretty spider web on the windscreen). A fall onto hard ground leaves a shoulder dislocated but leaves the arm with blood supply (physio).

I sometimes wander if it's a good thing I'm becoming more and more detached from this - will I reach a point where nothing phases me? I'm not so sure if that would be a good thing, but at the same time I wouldn't want every case to stay with me. In some professions more than others, you shouldn't take work home with you. How will I work out? Time will tell, but currently I'm happy with my reactions. I still have the internal monologue of "that's so cool!" followed by "Can I get you some pain relief?", but I don't know how that would apply to some of the more serious accidents.

Moral of the story? Make sure you leave things where they belong - otherwise a man in a little blue jumpsuit might be grinning at how cool it looks. And you'd need physiotherapy.

Common sense (and why it isn't always common)

A good deal of what we do in first aid is common sense. Anybody can do it - most children, when asked what to do if they cut themselves would be able to tell you to put a band aid on it. There is one little catch, however, that has shown me time and time again why such a simple thing to treat can be changed into something a lot more complicated.

From the newest member to the most hardened veteran of first aid (sounds silly, I know), I've seen people freeze up at certain types of injuries. Some people don't like blood (again sounds silly but I've seen first aiders go pale at the sight of it), while others don't like screaming patients. I've done it too, but I'm trying more and more to stop it. Sometimes your brain needs a few moments to collect itself when confronted with a particular sight, and it's something that you need to condition yourself out of in order to become better at this. Some injuries require immediate attention, so you won't be given those moments, and it's a trend I'm noticing going through the Paramedic literature that an important part of the job is getting around that initial mental hurdle to get back to that common sense.

But this raises another point - Paramedics condition themselves to adrenalin, as the job puts the body into a stressful state for frequent, long periods of time. This is a two edged sword; it allows the Paramedic to work in stressful situations to accomplish that which may not ordinarily be accomplished, but it can also lead to chronic fatigue and a depletion of mental resources. It can burn you out. A good Paramedic will be able to find that balance, the sweet spot between exhaustion and exhilaration that leaves them in the right frame of mind for the job. I've heard it's not easy, and not everyone can do it despite their best efforts. It can hit you straight away, or slowly wear you down after years on the job.

Will I be able to find this spot? I hope so, but I guess you'll only ever find out through a trial of fire. All else fails, I like to think I'll still be able to use my common sense.

What is wrong with you?

Sometimes we get cases that we just know are wasting our time.

It might be that you can still move the fingers you just 'dislocated', that the throwing up has nothing to do with the eight bottles of beer you just finished and must be due to internal bleeding (despite the lack of blood) and your obvious soberness. It might even be that you've just 'fainted'.

It's a funny thing, fainting. You see, we have these little things called oropharyngeal airways, which for unconscious patients just slide right in. Fits like a glove (providing of course you use the right size oropharyngeal airway). Unless of course you are (and of course you are not) faking - in which case you will gag and cough up the airway the second it's in - a natural and almost invariably an irrepressible response. Oh, we know what's going on now - but we have to play along with your little game because there's not much else we can do. This seems to be a popular activity for teeny-boppers when that young boy comes out on stage wearing almost more make up than said 'boppers...

But then there's the other cases, where the patient is just plain stupid. They profess that they wish to become a neurosurgeon (despite a distinct hate of all and any education establishments) so that they can perform brain surgery on themselves. I'm not making this up, I've had someone tell me this. And then there was a youth with severe stomach cramps after a two week binge on junk food and alcohol...

While the last two examples had patients who were there for genuine reasons (the first was there for reasons other than brain surgery), you still feel like your wasting your time - that Darwin determined long ago they should be left to nature. Of course we still treat them like any other patient who comes for help - but its these patients who treat that little bit faster so as to get them out the door, away so they cannot accost your ear drums with their taint. You feel that little stupor that comes with not using your brain for an extended period of time after dealing with these patients, and I at least get a little angry (but of course don't show it!) at their sheer ignorance of what the world is really like.

I like to think I treat all patients equally, but even I must admit I get on better and do that little bit extra for the patients you think are really worth treating - worth our time.

Trauma Junkie

Since writing this blog, a few friends have called me something which, while not necessarily inaccurate, I don't find too appealing.

Trauma Junkie.

In a sense, they are right. I like getting the 'big cases' where my hands get wet. I like being tested, forced to think on my toes and, I'll admit, the adrenalin rush is certainly an interesting experience.

Don't get me wrong - I never wish for someone to get in trouble, in fact in a perfect world my future career would be redundant and I'd be more than happy with that - it's just that this isn't a perfect world, and accidents do happen. So does stupidity, hate, greed, lust (and all those other enjoyable sins we hear so much about). I've become a bit of a junkie in the sense that I want to experience things so I can learn from them, observe and help when things go wrong. I want to be there for the 'big cases' so that if, and I hope this doesn't happen, I'm on my own in this situation without the support of a team or partner, I will be able to keep my cool.

Something of a recurring mantra on this blog - I want to be better. If that makes me a trauma junkie, so be it - as long as everyone goes home to a full family tonight, I'll be more than happy to stick with that title.

How little I've learned...

The thing I have to keep telling myself lately is that I don't even know if I'm in the traineeship yet. For all the posts, the experiences, the aspirations and hopes - I have to remind myself that I'm still in my infancy. That I'll end up getting into Paramedics somehow is obvious to me - I'm too damn stubborn. The question is how long will it take me?

So there's a few things I want to say to various people, those things you'll find below.

To NSW Ambulance Service;
I am what you're looking for. I am hard working, good with people, a quick learner and have a passion for doing more of what I've experienced so far in First Aid. I have a medical background, holding BBioMedSc(Hons) with experience in cancer and viral medical research. I am self-reliant but still love working in teams, efficient and (with what I've experienced so far) able to keep a cool head in potentially bad situations. Give me a chance, and I will not let you (or those who trust in me) down.

But I am young, and while I think I have experienced some things, I know they are nothing to what a Paramedic can experience on a daily basis. I am willing to learn, and for that I need you to teach. More than anything else, I need to remember that no matter how qualified I am (with my current degree, while I'm in training and long after I finish) I will always need to keep learning. I have long loved to learn, having spent most of my life in educational institutions, but the real learning starts when you let me into your vehicles.

To any crew I (hopefully) will work with;
Be patient, for although I may be eager I know I am only human and will make mistakes. Let me know when I'm doing things wrong, but more importantly don't be afraid to also let me know when I'm doing things right. Guide me until you think I'm ready.

I will try to keep my patients happy and safe, I will introduce myself to them by name and make sure I listen to what they have to say. I will treat everyone with respect, even though I may not always be treated the same. That is life, and a lesson I've learned somewhat already but will continue to learn. I will treat them as best I can, explaining everything I do and why. No matter how much smarter, better trained or higher in the social hierarchy I think I may be compared to those I assist , at the end of the day we are public servants, and they are the public - my humility can help my patient just as much as gauze and saline (but that doesn't mean I have to respect every drunk ;P).

I will do what I can, but I know I can't save everybody. I will accept that when it happens, and although it's easy to write now I'll need your help when it happens (even though I may be too proud to ask). Make me good at what I do, but always remind me to become better.



Making the decision to follow this path was one of the hardest decisions I've ever had to make - but since making it I haven't had a second thought. Where I was afraid of beginning my education again, I have found a fascination for reading EMS text books, reports, stories and blogs. Where I was scared of changing the direction of my life, I've found an inner peace and sense of 'rightness' I haven't felt in years.

The more I've learned in life, the more I realise how little I've learned and how much more there is out there to know. An old friend of mine once told me that was the first step to wisdom, but that the path was long and easily lost. While he left us several years back, I'm sure that if I could ask him today what he though, he'd tell me to follow my heart.

I only ask the Ambulance Service of New South Wales to give me a shot and see what I am capable of. Teach me, train me - and no matter how good I may become, always remind me just how little I've learned.

Schedule

So I've decided to set in stone a schedule to keep me posting here - as Jeff Atwood puts it, 'posting in obscurity' until I 'suck less'. I've been reading his blog for months now and am constantly amazed by the things he pulls out.

Anyway, back to this blog... The last post was a bit of a downer, so I thought I'd make sure the next one ended on a more positive note. That doesn't mean for every bad story there is a good one - only a few people call an Ambulance just to see the pretty lights.

This story is the favorite of Allen's, my CO in St John.

I was in the First Aid post at Vodafone Arena, another boring shift where not much was happening. Suddenly, a woman pops her head in the door and asks for aspirin. A little bell went off in my head - nobody asks for aspirin. Paracetamol, yes, but never aspirin. Flags went up in my mind and I ran through the standard routine;
'Is it for you?'
'No.'
'Who's it for?'
'My mother-in-law.'
'Why do you ask for aspirin in particular?'
'She's having some chest pain and I thought it would help.' She's right - if it's cardiac chest pain aspirin can help break up any clots that might be contributing to chest pain. But if that's the case, it's time to take a little trip to hospital. I give her the spiel about how technically we're handing over medication, so we have to be with and talking to the patient, but that I was more than happy to follow her back to wherever her mother-in-law was.

And off we went. On the way we made idle chatter, how long the pain had lasted, how was the weather, that sort of thing... Apparently the woman was a cardiac nurse, that was why she knew to ask for aspirin. We reach the mother-in-law, and after one look I'm at her side taking observations while requesting for a wheelchair and oxygen to be brought over along with an ambulance - her pulse was erratic and she was not looking good. Aspirin was not going to fix this. Wheeling her back to the FA post I was able to talk to her a bit more and get a more accurate history - double bypass, on blood pressure meds but had forgotten to take them today (the number of times I've heard that... but that's a rant on it's own for another day).

One last thing; she was allergic to aspirin.

It amazes me that a cardiac nurse had not noticed the condition she was in, and was ready to give her medication that quite possibly could have killed her - suffice to say she was very embarrassed and more than a little scared. We had an ambulance come in and drive them both off to hospital, not before confirming on a 6 lead ECG things weren't right in the ticker department. All things considered she would have made a full recovery after getting back on her meds, so this post teaches us three things;
1) Never trust the friends or family, no matter how well they 'know' the patient,
2) Don't forget to take important, life saving medication and
3) Even Cardiac Nurses can hope to be better at what they do ;)

Be safe.